Qualified Blind Trust Agreement

QUALIFIED BLIND TRUST AGREEMENT

I. PARTIES AND EFFECTIVE DATE

INTERESTED PARTY / SETTLOR (the "Interested Party"):

Name: [OFFICEHOLDER FULL LEGAL NAME]
Office Held or Sought: [TITLE — e.g., U.S. Senator, Cabinet Secretary, State Attorney General, Governor]
Appointing Authority / Confirming Body: [____]
Residence Address: [____]

INDEPENDENT TRUSTEE (the "Trustee"):

Name: [TRUSTEE INSTITUTION OR INDIVIDUAL]
Trustee Type: ☐ Financial institution ☐ Investment advisor registered under the Investment Advisers Act of 1940 ☐ Attorney ☐ Certified public accountant ☐ Bank trust department
Address: [____]

SUPERVISING ETHICS AUTHORITY:

• ☐ U.S. Office of Government Ethics (OGE) — Executive Branch
• ☐ U.S. Senate Select Committee on Ethics — Senate
• ☐ U.S. House Committee on Ethics — House
• ☐ State ethics commission: [NAME OF STATE COMMISSION]

EFFECTIVE DATE: This Qualified Blind Trust Agreement (the "Trust Agreement") is effective as of [__/__/____], subject to and contingent upon prior written approval by the Supervising Ethics Authority under Section XIII.

II. RECITALS

WHEREAS, the Interested Party currently holds, or is a nominee for, the public office identified in Section I, and is subject to the conflict-of-interest restrictions of 18 U.S.C. § 208 (or the analogous state statute);

WHEREAS, the Interested Party desires to confer upon an Independent Trustee the sole responsibility to administer the trust and to manage trust assets without participation by, or the knowledge of, the Interested Party or any other "interested party" within the meaning of 5 C.F.R. § 2634.201(a), in order to reduce real or apparent conflicts of interest;

WHEREAS, the Trustee meets the strict requirements for independence set forth in the Ethics in Government Act of 1978, 5 U.S.C. app. § 102(f)(3), and 5 C.F.R. §§ 2634.405–2634.406, and has executed a Certificate of Independence in the form prescribed by OGE;

WHEREAS, the parties intend that this Trust Agreement constitute a "qualified blind trust" within the meaning of 5 U.S.C. app. § 102(f)(3) and 5 C.F.R. § 2634.401, conditioned upon written approval by the Supervising Ethics Authority; and

WHEREAS, the Interested Party acknowledges that, until and unless approval is granted, the Interested Party remains obligated to recuse from particular government matters affecting the assets contributed and to comply with all applicable disclosure obligations.

NOW, THEREFORE, in consideration of the foregoing recitals and the covenants set forth herein, the parties agree as follows.

III. INDEPENDENCE OF TRUSTEE

A. Independence Requirements. The Trustee certifies, as of the Effective Date and continuing throughout the term of the trust, that the Trustee:

1. Is independent of and not associated with any interested party, so that the Trustee cannot be controlled or influenced in the administration of the trust by any interested party;
2. Is not and has not been an employee of any interested party, an employer of any interested party, a partner of any interested party, a co-participant in any investment or business venture with any interested party, a creditor or debtor of any interested party (other than as creditor or debtor on customary commercial terms), or an attorney, accountant, advisor, or relative of any interested party, in each case during the [____] years preceding the Effective Date and during the term of the trust;
3. Is not a member of the Interested Party's immediate family; and
4. Is otherwise qualified to act as a fiduciary under applicable law.

B. Certificate of Independence. Concurrently with execution of this Trust Agreement, the Trustee shall execute and deliver to the Supervising Ethics Authority a Certificate of Independence in the form prescribed by OGE (or the analogous form prescribed by the state authority).

C. Continuing Obligation. The Trustee shall promptly notify the Supervising Ethics Authority and the Interested Party in writing if any fact or circumstance arises that would render the foregoing certification inaccurate.

IV. CONTRIBUTION OF ASSETS

A. Initial Trust Corpus. The Interested Party hereby transfers and conveys to the Trustee, to be held and administered under the terms of this Trust Agreement, the assets described in Exhibit A (the "Initial Trust Corpus"). The Initial Trust Corpus shall be disclosed in full to the Supervising Ethics Authority but, after the trust's establishment, shall (subject to Section V) not be disclosed to the Interested Party except as required to confirm divestiture under Section IV.D.

B. Subsequent Contributions. The Interested Party may contribute additional assets to the trust from time to time, provided that any such contribution is disclosed in advance to the Supervising Ethics Authority.

C. Distinct Assets. The Trustee shall keep all trust assets separate from the Trustee's other property and shall maintain books and records sufficient to discharge the Trustee's fiduciary, tax, and reporting obligations.

D. Divestiture / Conversion of Original Assets. The Trustee shall have full and sole discretion to sell, exchange, reinvest, or otherwise dispose of any asset constituting the Initial Trust Corpus, and shall use reasonable efforts to dispose of any asset that, in the Trustee's judgment, would, if retained, give rise to a continuing or apparent conflict of interest. The Trustee shall notify the Interested Party only that a specific original asset has been fully disposed of (so that the Interested Party may, in reliance thereon, cease recusal as to that matter), in accordance with 5 C.F.R. § 2634.408.

V. COMMUNICATION RESTRICTIONS

A. General Prohibition. Except as expressly permitted by this Section V or by written advance approval of the Supervising Ethics Authority, the Trustee shall not communicate with any interested party (or representative thereof) concerning the trust, and no interested party shall communicate with the Trustee concerning the trust.

B. Permitted Communications. The following communications are permitted:

1. Annual report to OGE/ethics authority of the aggregate fair-market value of the trust corpus as of the end of the preceding calendar year;
2. Annual report to the Interested Party of (i) the aggregate fair market value of the trust corpus and (ii) the aggregate net income or loss of the trust for the preceding calendar year, without any identification of specific holdings, transactions, or sources of income, in each case as required for federal (and applicable state) income tax filing;
3. Information necessary for the Interested Party to file required tax returns, in the form of an aggregated grantor letter or Schedule K-1 reflecting trust income, deductions, and credits — without identification of underlying holdings to the extent practicable consistent with applicable tax-reporting law;
4. Notice that a specific original asset has been disposed of in accordance with Section IV.D;
5. Notice that the trust holds insufficient cash to pay required taxes or trustee fees, and a request for additional cash contribution from the Interested Party;
6. Written communications pre-screened by the Supervising Ethics Authority in accordance with 5 C.F.R. § 2634.404; and
7. Such other communications as may be required by court order, subpoena, or applicable law, with prior notice to the Supervising Ethics Authority where lawful.

C. Prohibited Communications. Without limiting the foregoing, the Trustee shall not (and shall direct any sub-managers, brokers, or agents not to) communicate to any interested party:

1. The identity of any asset held by the trust (other than original assets, until disposed of);
2. The identity of any asset purchased, sold, or otherwise transferred by the trust;
3. The identity of any income source or counterparty;
4. Any investment strategy, allocation, or transaction; or
5. Any information from which any of the foregoing could reasonably be inferred.

D. Confidentiality Agreements with Sub-Advisors. Any sub-advisor, broker, investment manager, custodian, or other agent engaged by the Trustee shall execute a confidentiality agreement in substantially the form prescribed by OGE before being engaged.

VI. TRUSTEE INVESTMENT DISCRETION

A. Sole and Exclusive Discretion. The Trustee shall have sole and exclusive responsibility for investment, retention, sale, and reinvestment of trust assets, exercising the judgment of a reasonable and prudent fiduciary, and shall not seek or accept instructions from the Interested Party as to specific investments, sectors, allocations, or counterparties.

B. Permitted Investment Categories (Interested Party may, in this Section only, state general categories that the Trustee may avoid; no specific direction is permitted):

• ☐ The Trustee shall avoid investment in securities of any company that does substantial business with [AGENCY] (general category, no identification of specific issuers);
• ☐ Other general category restriction: [____].

C. No Knowledge Transfer. The Interested Party shall not, by any act or communication, attempt to influence the Trustee's investment decisions.

VII. PROHIBITED COMMUNICATIONS BY INTERESTED PARTY

The Interested Party shall not:

1. Inquire about the identity or status of any holding;
2. Make any suggestion or request regarding particular investments;
3. Receive or retain any information about trust holdings other than as expressly permitted by Section V; or
4. Permit any representative, attorney, accountant, family member, or business associate to do any of the foregoing on the Interested Party's behalf.

Any inadvertent receipt of prohibited information shall be promptly reported in writing to the Supervising Ethics Authority.

VIII. TAX REPORTING AND OBLIGATIONS

A. Grantor Trust Status. This trust is intended to be treated as a grantor trust for federal income tax purposes under 26 U.S.C. §§ 671 et seq., such that all items of income, deduction, and credit of the trust are reportable by the Interested Party on the Interested Party's individual income tax returns.

B. Annual Tax Information. The Trustee shall furnish to the Interested Party each year, no later than the date required to permit timely tax filing, an aggregated grantor letter (or Schedule K-1) reflecting the trust's aggregate income, deductions, and credits, in a form designed to maintain the blindness of the trust to the maximum extent consistent with applicable tax-reporting law.

C. Payment of Taxes. The Interested Party shall remain liable for all taxes attributable to trust income. The Trustee shall, upon request, make distributions to the Interested Party in such amounts as the Trustee determines to be reasonably necessary to pay the federal and state income tax liability attributable to trust income.

IX. TRUSTEE COMPENSATION AND EXPENSES

The Trustee shall be entitled to reasonable compensation for services rendered hereunder, as set forth in Exhibit B, and to reimbursement for reasonable expenses, including custodian fees, sub-advisor fees, accounting and tax-preparation fees, and legal fees, all payable from the trust corpus.

X. SUCCESSION, RESIGNATION, AND REMOVAL OF TRUSTEE

A. Resignation. The Trustee may resign upon not less than [60] days' prior written notice to the Interested Party and the Supervising Ethics Authority. Such resignation shall not be effective until a successor trustee has been approved in writing by the Supervising Ethics Authority and has accepted the trusteeship.

B. Removal. The Trustee may be removed by the Interested Party only with the prior written approval of the Supervising Ethics Authority.

C. Successor Trustee Qualifications. Any successor trustee shall meet the independence requirements of Section III and shall execute a Certificate of Independence and acceptance of trusteeship in the form prescribed by OGE.

XI. TERMINATION

A. Termination Events. This trust shall terminate upon the earliest of:

1. The Interested Party ceasing to hold the office identified in Section I and ceasing to be a candidate for or nominee to any other position to which the conflict-of-interest restrictions of 18 U.S.C. § 208 (or analogous state law) apply;
2. The death of the Interested Party;
3. Mutual written agreement of the Interested Party and the Trustee, with prior written approval of the Supervising Ethics Authority; or
4. Such other event as may be approved in writing by the Supervising Ethics Authority.

B. Distribution Upon Termination. Upon termination, the Trustee shall, after payment of all expenses and reserves for liabilities, distribute the remaining trust corpus to the Interested Party (or to the Interested Party's estate or designated beneficiaries) and shall furnish a final accounting to the Interested Party and the Supervising Ethics Authority.

C. Final Public Report. Following termination, the Trustee shall provide to the Supervising Ethics Authority a final report listing all assets held by the trust at termination, in accordance with 5 C.F.R. § 2634.408.

XII. PROHIBITED RELATIONSHIPS AND ACTIONS

For the avoidance of doubt, throughout the term of the trust, no interested party shall:

1. Serve as an officer, director, employee, partner, or consultant of the Trustee;
2. Have any creditor-debtor relationship with the Trustee other than as may exist on customary commercial terms;
3. Receive compensation or any benefit from the Trustee outside of trust distributions; or
4. Use any non-public information learned in the course of official duties to direct or influence trust investments (in addition to other obligations under federal law).

XIII. APPROVAL BY SUPERVISING ETHICS AUTHORITY

A. Condition Precedent. This Trust Agreement shall not constitute a "qualified blind trust" for purposes of 5 U.S.C. app. § 102(f)(3), and shall not relieve the Interested Party of any recusal or disqualification obligation, until and unless this Trust Agreement, the Trustee, and (if applicable) any sub-advisor have been approved in writing by the Supervising Ethics Authority in accordance with 5 C.F.R. § 2634.403.

B. Submissions. Concurrently with execution, the parties shall submit to the Supervising Ethics Authority:

1. A fully executed copy of this Trust Agreement;
2. A Certificate of Independence executed by the Trustee;
3. A Certificate of Compliance executed by the Interested Party;
4. A complete inventory of the Initial Trust Corpus (Exhibit A);
5. The proposed schedule of trustee compensation (Exhibit B); and
6. Confidentiality agreements with any sub-advisors.

C. Modifications Required by Authority. The parties agree to make any modifications to this Trust Agreement reasonably required by the Supervising Ethics Authority as a condition of approval.

XIV. GOVERNING LAW; STATE-SPECIFIC VARIATIONS

A. Governing Law. This Trust Agreement shall be governed by and construed in accordance with the laws of the State of [____], except that, with respect to a federal officeholder, the federal Ethics in Government Act and 5 C.F.R. part 2634 shall control to the extent of any conflict.

B. State-Specific Variations.

• ☐ Federal (Executive Branch) — 5 U.S.C. app. § 102(f)(3); 5 C.F.R. §§ 2634.401–2634.408. Approval by U.S. Office of Government Ethics required. Use current-year OGE Model Qualified Blind Trust Provisions and Certificates.
• ☐ U.S. Senate — Senate Select Committee on Ethics; Senate Rule 34; approval required by Committee.
• ☐ U.S. House — House Committee on Ethics; House Rule 25; approval required by Committee.
• ☐ Texas — Tex. Gov't Code Ch. 572, Subchapter F (blind trust for state officeholders; Texas Ethics Commission oversight).
• ☐ California — Cal. Gov't Code § 87103 and 2 Cal. Code Regs. § 18230 (FPPC regulation of blind trusts; Form 700 disclosure).
• ☐ New York — N.Y. Public Officers Law § 74; Commission on Ethics and Lobbying in Government (COELIG, successor to JCOPE).
• ☐ Other state — [STATE STATUTE / COMMISSION]: [____].

XV. MISCELLANEOUS

A. Notices. All notices shall be in writing and delivered as provided in Section I (or to such other address as a party designates in writing). Copies of all notices shall be provided concurrently to the Supervising Ethics Authority.

B. Entire Agreement. This Trust Agreement, together with the Exhibits and the Certificates, constitutes the entire agreement between the parties with respect to the subject matter hereof.

C. Amendment. This Trust Agreement may be amended only by a written instrument signed by the Interested Party and the Trustee and approved in writing by the Supervising Ethics Authority.

D. Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

E. Counterparts; Electronic Signatures. This Trust Agreement may be executed in counterparts, each of which shall be deemed an original, and electronic signatures shall be effective in accordance with the federal E-SIGN Act and applicable state UETA.

F. No Third-Party Beneficiaries. Except for the Supervising Ethics Authority, which is an intended third-party beneficiary with respect to the certifications, communication restrictions, and approval rights set forth herein, this Trust Agreement is for the sole benefit of the parties and their permitted successors.

XVI. EXECUTION

IN WITNESS WHEREOF, the parties have executed this Qualified Blind Trust Agreement as of the Effective Date first written above, subject to the approval contemplated by Section XIII.

INTERESTED PARTY / SETTLOR:

___________________________________ Date: [__/__/____]
[OFFICEHOLDER NAME]

INDEPENDENT TRUSTEE:

___________________________________ Date: [__/__/____]
[TRUSTEE NAME]

Title (if institutional): [____]

SUPERVISING ETHICS AUTHORITY APPROVAL:

The undersigned, on behalf of the Supervising Ethics Authority identified in Section I, hereby approves this Trust Agreement, the Trustee, and (if applicable) the sub-advisor identified in the accompanying submissions, as constituting a qualified blind trust within the meaning of 5 U.S.C. app. § 102(f)(3) and 5 C.F.R. § 2634.401.

___________________________________ Date: [__/__/____]
[ETHICS AUTHORITY OFFICIAL NAME, TITLE]

EXHIBIT A — INITIAL TRUST CORPUS (CONFIDENTIAL — FILED WITH SUPERVISING ETHICS AUTHORITY)

EXHIBIT B — TRUSTEE COMPENSATION SCHEDULE

EXHIBIT C — CERTIFICATE OF INDEPENDENCE (TO BE EXECUTED IN OGE FORM)

EXHIBIT D — CERTIFICATE OF COMPLIANCE (TO BE EXECUTED IN OGE FORM)

Sources and References

• Ethics in Government Act of 1978, 5 U.S.C. app. § 102(f)(3) (Qualified Blind Trust) and § 102(f)(4) (Qualified Diversified Trust)
• 5 C.F.R. Part 2634, Subparts D and E — Executive Branch Qualified Trusts; § 2634.401 (Overview), § 2634.402 (Standards), § 2634.403 (Approval), § 2634.404 (Permitted Communications), § 2634.405 (Trustee Independence), § 2634.408 (Reporting on Termination) — https://www.ecfr.gov/current/title-5/chapter-XVI/subchapter-B/part-2634
• U.S. Office of Government Ethics — Qualified Trusts (Model Provisions, Certificates of Independence and Compliance, updated 2025) — https://www.oge.gov/web/oge.nsf/Resources/Qualified+Trusts
• 18 U.S.C. § 208 (Acts Affecting a Personal Financial Interest)
• 26 U.S.C. §§ 671–678 (Grantor Trust Rules)
• Tex. Gov't Code Ch. 572, Subchapter F; Cal. Gov't Code § 87103 and 2 Cal. Code Regs. § 18230; N.Y. Public Officers Law § 74 (COELIG)
• 77 Fed. Reg. 39143 (July 2, 2012) — OGE Final Rule reorganizing 5 C.F.R. part 2634 subparts D and E